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Biofeedback therapy for dyssynergic defecation

World Journal of Gastroenterology 2006年第44期12卷 7069-7074页

作者： Giuseppe Chiarioni Steve Heymen William E Whitehead Gastrointestinal Rehabilitation Division Valeggio sul Mincio Hospital Azienda Ospedaliera and University of Verona Valeggio sul Mincio Italy UNC Center for Functional Gastrointestinal and Motility Disorders University of North Carolina at Chapel Hill Chapel Hill NC United states

dyssynergic defecation is one of the most common forms of functional constipation both in children and adults; it is defined by incomplete evacuation of fecal material from the rectum due to paradoxical contraction or failure to relax pelvic floor muscles when straining to defecate. This is believed to be a behavioral disorder because *** no associated morphological or neurological abnormalities, and consequently biofeedback training has been recommended for treatment. Biofeedback involves the use of pressure measurements or averaged electromyographic activity within the anal canal to teach patients how to relax pelvic floor muscles when straining to defecate. This is often combined with teaching the patient more appropriate techniques for straining （increasing intra-abdominal pressure） and having the patient practice defecating a water filled balloon. Tn adults, randomized controlled trials show that this form of biofeedback is more effective than laxatives, general muscle relaxation exercises （described as sham biofeedback）, and drugs to relax skeletal muscles. Moreover, its effectiveness is specific to patients who have dyssynergic defecation and not slow transit constipation. However, in children, no clear superiority for biofeedback compared to laxatives has been demonstrated. Based on three randomized controlled studies in the last two years, biofeedback appears to be the preferred treatment for dyssynergic defecation in adults.

关键词： Biofeedback Constipation Pelvic floor dyssynergia dyssynergic defecation Functional defecation disorders Randomized controlled trials

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